Skip Navigation


European Heart Journal Advance Access originally published online on April 29, 2008
European Heart Journal 2008 29(11):1473-1474; doi:10.1093/eurheartj/ehn177
This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
29/11/1473-a    most recent
ehn177v1
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Schroeder, S.
Right arrow Articles by Bax, J. J.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Schroeder, S.
Right arrow Articles by Bax, J. J.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Recommendations or mere prose?: reply

Stephen Schroeder

Division of Cardiology
Department of Medicine
University of Tuebingen
Tuebingen
Germany
Email: stephen.schroeder{at}med.uni-tuebingen.de

Stephan Achenbach

Department of Cardiology
University of Erlangen
Erlangen
Germany

Frank Bengel

Johns Hopkins University Medical Institutions—
Cardiovascular Nuclear
Baltimore
USA

Christof Burgstahler

Division of Cardiology
Department of Medicine
University of Tuebingen
Tuebingen
Germany

Filippo Cademartiri

Department of Radiology
Erasmus Medical Center
Rotterdam
The Netherlands
and
Department of Radiology and Cardiology
Azienda Ospedaliero Universitaria
Parma
Italy

Pim J. de Feyter

Department of Cardiology and Radiology
Erasmus Medical Center
Rotterdam
The Netherlands

Richard George

Department of Medicine
Division of Cardiology
Johns Hopkins University
Baltimore
USA

Philipp Kaufmann

Department of Cardiology
University of Zurich
Zurich
Switzerland

Andreas F. Kopp

Department of Diagnostic Radiology
University of Tuebingen
Tuebingen
Germany

Juhani Knuuti

Turku PET Center
Turku University Central Hospital
Turku
Finland

Dieter Ropers

Department of Cardiology
University of Erlangen
Erlangen
Germany

Joanne Schuijf

Department of Cardiology
Leiden University
Leiden
The Netherlands

Laurens F. Tops

Department of Cardiology
Leiden University
Leiden
The Netherlands

Jeroen J. Bax

Department of Cardiology
Leiden University
Leiden
The Netherlands

Thank you for providing us with the opportunity to reply to the correspondence sent in by Dr Van Brabant concerning our recent article on cardiac computed tomography (CT).1 Although he raises interesting points, they should not go without comment.

Dr Van Brabant states that the high negative predictive value of coronary CT angiography was found in studies with a high prevalence of disease and will not hold up if the test is applied to patients with a lower pre-test likelihood. We respectfully disagree with this statement. In fact, as an effect of Bayesian statistics, negative predictive value will increase as the prevalence of disease decreases.2 This effect works in favour of coronary CT angiography since clinically; it will usually be applied to lower risk populations.3

Dr Van Brabant criticizes that CT angiography has often been tested in populations which ‘...do not need it...’. The underlying reason is that evaluation requires comparison with the standard of reference, in this case invasive angiography, and therefore studies had to be performed in populations which already had been scheduled for angiography.

As to the author's criticism of Goldstein's cost-effectiveness analyses,4 we are not in a position to reply to critique of other authors' work, but even though not in agreement with the harsh critique voiced here, we do share the opinion that more evidence particularly concerning implications and cost-effectiveness of coronary CT angiography in specific clinical situations, especially in relation to other techniques (MR, Echo, SPECT, PET), would be tremendously helpful.

References

  1. Schroeder S, Achenbach S, Bengel F, Burgstahler C, Cademartiri F, de Feyter P, George R, Kaufmann P, Kopp AF, Knuuti J, Ropers D, Schuijf J, Tops LF, Bax JJ. Cardiac computed tomography: indications, applications, limitations, and training requirements: report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology. Eur Heart J (2008) 29:531–556.[Abstract/Free Full Text]
  2. Schwartz JS. Clinical decision-making in cardiology. In: Heart Disease—Zipes DP, Libby P, Bonow RO, Braunwald E, eds. (2005) 7th ed. Philadelphia: Elsevier Saunders. 27–34.
  3. Hendel RC, Patel MR, Kramer CM, Poon M, Hendel RC, Carr JC, Gerstad NA, Gillam LD, Hodgson JM, Kim RJ, Kramer CM, Lesser JR, Martin ET, Messer JV, Redberg RF, Rubin GD, Rumsfeld JS, Taylor AJ, Weigold WG, Woodard PK, Brindis RG, Hendel RC, Douglas PS, Peterson ED, Wolk MJ, Allen JM, Patel MR. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. J Am Coll Cardiol (2006) 48:1475–1497.[Free Full Text]
  4. Goldstein JA, Gallagher MJ, O'Neill WW, Ross MA, O'Neil BJ, Raff GL. A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol (2007) 49:863–871.[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
29/11/1473-a    most recent
ehn177v1
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Schroeder, S.
Right arrow Articles by Bax, J. J.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Schroeder, S.
Right arrow Articles by Bax, J. J.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?